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NavMed 369 




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UNITED STATES NAVY 



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Rear Admiral Bartholomew W. Hogan MC USN - Surgeon General 
Captain Leslie B. Marshall MC USN (RET) - Editor 



Vol. 31 



Friday, 7 March 1958 



No. 5 



TABLE OF CONTENTS 



Historical Fvmd of the Navy Medical Department Z 

Management of Iron Deficiency Anemia 3 

Farmer' s Lung 6 

Staphylococci 8 

Sympathectomy for Raynaud's Phenomenon 10 

Buckling of the Aortic Arch 13 

Liver Biopsy 14 

Supervoltage Therapy in Cancer of the Bladder " 17 

Total Adrenalectomy 19 

Venereal Disease Seminar 20 

Poison Control Centers 21 

Notes on Eighteenth Annual Congress on Industrial Health ". . 27 

University of Pennsylvania Changes Curricula 28 

Training Programs in Atomic Medicine 28 

Course in Blood Procurement 29 

Obstetrical and Gynecological Seminar 30 

Space Medicine Branch of Aero Medical Association 30 

Recent Research Reports 30 

IN MEMORIAM 31 

From the Note Book 32 

DENTAL SECTION 

MD Manual - Chapter Six 34 Changes in Rating 35 

Change of Entries on SF 603 .... 34 "Operation Build-Up" 35 

RESERVE SECTION 

Reserve Program in a Pay Status 37 Training for Inactive Reservists 38 
Annual Meeting of Aero Medical Association. . , 38 
PREVENTIVE MEDICINE SECTION 

Antibiotic Residues in Food 39 



Medical News Letter, Vol. 31, No. 5 



HISTORICAL FUND 
of the 
NAVY MEDICAL DEPARTMENT 



A committee has been formed with representation from the Medical 
Corps, Dental Corps, Medical Service Corps, Nurse Corps, and 
Hospital Corps for the purpose of creating a fund to be used for the 
collection and maintenance of items of historical interest to the Medical 
Department. Such items will include, but will not be limited to, por- 
traits, memorials, etc. , designed to perpetuate the memory of dis- 
tinguished members of the Navy Medical Department. These mennoriala 
will be displayed in the Bureau of Medicine and Surgery and at the 
National Naval Medical Center. Medical Department officers, active 
and inactive, are invited to naake small contributions to the fund. It 
is einphasized that all donations must be on a strictly voluntary basis. 
Funds received will be deposited in a Washington, D, C, bank to the 
credit of the Navy Medical Department Historical Fund, and will be 
expended only as approved by the Committee or its successor and for 
the objectives stated. 

It is anticipated that an historical committee will be organized at each 
of our medical activities. If you desire to contribute^ please do so 
through your local historical committee or send your check direct, 
payable to Navy Medical Department Historical Fund, and mail to: 

Treasurer, N. M. D. Historical Fund 
Bureau of Medicine and Surgery (Code 14) 
Department of the Navy 
Washington 25, D. C. 



Committee 

F. P. Gilmore, Rear Admiral (MC) USN, Chairman 
R. W. MALONE, Rear Admiral (DC) USN 
W.C. CALKINS, Captain (MSC) USN 
W. L. JACKSON, Captain (NC) USN 
T.J. HICKEY, Secretary-Treasurer 



Medical News Lietter, Vol. 31, No. 5 



Policy 



The U.S. Navy Medical News Letter, is basically aii official Medical 
Department publication inviting the attention of officers of the Medical 
Department of the Regular Navy and Naval Reserve to timely up-to-date 
items of official and professional interest relative to medicine, dentistry, 
and allied sciences. The amount of information used is only that necessary 
to inform adequately officers of the Medical Department of the existence 
and source of such information. The items used are neither intended to be, 
nor are they, susceptible to use by any officer as a substitute for any item 
or article in its original form. All readers of the News Letter are urged 
to obtain the original of those items of particular interest to the individual. 

Management of Iron Deficiency Anemia 

Few diseases in medicine can be diagnosed so easily and treated so 
effectively as iron deficiency anemia. Unfortunately, this anemia is often 
not diagnosed properly. Even more frequently, its treatment is haphazard 
or ineffectual. 

Since the introduction of red blood cell constants by Wintrobe, anemias 
have been classified into three main categories; (1) macrocytic, (2) normo- 
chromic normocytic, and (3) hypochromic microcytic. Iron deficiency pro- 
duces the last, a hypochromic microcytic anemia. In this type of anemia, 
the mean corpuscular volume is less than 80 cubic microns {normal 82-92), 
and the mean corpuscular hemoglobin concentration is less than 32% (normal 
32-37). 

The world over, iron deficiency anemia is probably the most common 
form of blood disorder. In the United States, at present it is about equal 
in frequency to simple chronic anemia. The latter anemia, as character- 
ized by Wintrobe 's constants is normochromic normocytic. This type is 
often seen in malignant neoplasms, chronic infections, or inflammatory 
diseases, as well as in other conditions. In the United States, there is no 
geographic predisposition to hypochromic microcytic anemia. However, 
it is related to poor social and economic conditions in backward areas where 
deficiency of dietary iron accompsmies other nutritional deficits. 

Hypochromic anemia is seen in all age groups, but it has greater prev- 
alence during infancy, adolescence, and women's reproductive years. The 
adolescent girl, whose menses are frequently irregular and excessive, who 
is growing rapidly, and who often indulges in food fads, may easily develop 
iron deficiency anemia. With transfer of iron from maternal stores to the 
fetus, blood loss at the time of delivery, and increased iron excretion in the 
mother's milk, pregnancy, childbirth, and lactation take their toll of iron. 



Medical News Letter, Vol. 31, No. 5 



Throughout these various periods, further reduction of iron stores may 
be produced by chronic hemorrhage from any source. 

Finally, the aged, with no teeth or with ill-fitting dentures and fre- 
quently with no desire to eat, may fail to keep pace with iron losses from 
chronic slight bleeding or rarely even with normal iron excretion. Thus, 
iron deficiency anemia may be present at any age from infancy to senes- 
c enc e . 

It is estimated that of all cases of iron deficiency in this country, 90% 
occur in women. This is not difficult to explain when it is realized that the 
iron loss from menses and childbearing, plus a tendency to eat less sub- 
stantial diets in the hectic pace of rearing children or maintaining a slim 
waistline. The difference in sex incidence of hypochromic anemia tends to 
disappear in children and in adults after menopausal age. 

In general, the symptoms of iron deficiency anemia are conimon to 
other forms of anemia: pallor, easy fatigability, irritability, weakness, 
dyspnea, palpitation, giddiness or even syncope, tinnitus, anorexia, flat- 
ulence, constipation, and often menstrual abnormalities varying from men- 
orrhagia to amenorrhea. Most of these complaints appear slowly and 
insidiously with their onset difficult to date. 

The symptom complex of glossitis, dysphagia, hypochlorhydria, and 
hypochromic anennia — Plummer-Vinson syndrome — is rarely seen in the 
United States. 

All that is needed for the diagnosis of hypochromic anemia in most 
cases is a well-stained blood film. The red blood cells are smaller than 
normal (microcytosis) with a thin rim of pink-staining hemoglobin surround- 
ing a large clear central area like a rubber washer (hypochromia). Some 
of these hypochromic cells may assume the appearance of a bull's-eye and 
are called target cells. Furthermore, instead of the usual uniformity of 
similar sized erythrocytes, the film in iron deficiency anemia shows con- 
siderable variation in size (anisocytosis) and shape (poikilocytosis). Exam- 
ination of the stained blood film — which takes no longer than five minutes — 
is too often neglected. Frequently, the patient with simple hypochromic 
anemia is given an expensive course of vitamins and liver extract when iron 
is the only treatn^ent needed. 

Specific causes of iron deficiency anemia are: menstruation, pregnancy 
and hemorrhage. 

Hemorrhage is almost invariably the cause of iron deficiency anemia 
in adult males. In any investigation of the site of hemorrhage in the male, 
the gastrointestinal tract must bear the brunt of suspicion. One can usually 
discount bleeding gums as a source of blood loss sufficient to cause iron 
deficiency. However, the small telangiectases seen on the tongue, buccal 
mucosa, palate, and pharynx should call attention to hereditary telangiec- 
tasis. This is a source of blood loss that is often quite significant due to 
lesions in the stomach and bowel. Esophageal neoplasms and varices are 



Medical News Letter, Vol. 31, No. 5 



potential sources of blood loss, usually easily demonstrated radiograph- 
ically or by direct visualization. Likewise, the stomach is a frequent 
source of chronic blood loss sufficient to produce iron deficiency anemia. 
Peptic ulcer or gastric neoplasms usually can be demonstrated by roentgen 
examination or gastroscopically. More difficult unless specially searched 
for are the ulcerations of the mucosa caused by hiatus hernia. Gastritis 
without discrete erosions may be responsible for chronic bleeding and may 
be extremely difficult to demonstrate. 

In any consideration of the gastrointestinal tract as a source of blood 
loss, one must remember that this loss may be intermittent and not demon- 
strable in a single or even in several exanninations of stools for occult 
blood. Furthermore, it has been shown that bleeding into the proximal 
portions of the bowel can occur so slowly that as much as 30 cc. of blood 
Cein be lost daily without producing a positive stool guaiac test. For pur- 
poses of emphasis, this might amount to almost a liter of blood lost per 
month — certainly, enough to produce iron deficiency anemia in a short time. 

Hemorrhages from other sites, such as nosebleeds, wounds, or urinary 
blood loss, are usu3.11y readily noticed and present little problem in determin- 
ing the basis of hypochromic anemia. Another source of blood loss which 
may escape attention unless specifically sought is blood donation. Donation 
of only three pints a year requires the absorption of 1. 7 to 2. 1 mg. of iron 
per day above the basic requirements in order that iron deficiency naay not 
ensue. 

It cannot be too strongly emphasized that iron deficiency anemia in 
an adult male is due to blood loss almost without exception. To ascribe hypo- 
chromic anemia in a man to inadequate dietary iron intake is almost always 
erroneous. 

In the treatment of iron deficiency anemia, there are two basic points 
to consider: (1) correction of the hemoglobin «uid tissue iron deficiency, and 
(2) recognition and, if possible, correction of the cause for the anemia which 
in the preponderance of cases will be due to blood loss. Usually, the second 
phase of therapy is by far the more important. 

Ferrous salts are better absorbed than ferric compounds so that the 
fornner are most frequently employed therapeutically. Ferrous sulfate and 
ferrous gluconate are among the least expensive iron salts emd have been 
repeatedly demonstrated to be effective. 

The response to iron administration in hypochromic anemia is often 
dramatic. Within 24 to 48 hours, the patient may experience a welcome 
sense of well-being andnotean increased — sometimes ravenous — appetite. 
Reticulocytes begin to rise in 5 to 7 days, not infrequently reaching a 10 to 
15% peak at the tenth to fourteenth day of treatment, returning to normal 
after about 3 weeks. The height of the reticulocyte response is inversely 
proportional to the initial hemoglobin level. About the seventh to tenth day, 
the hemoglobin begins to rise and regenerates at a rate of approximately 
0. 2 gm. per day, with return to normal levels in 4 to 8 weeks. ' 



6 Medical News Letter, Vol, 31, No. 5 



If no response to adequate doses of iron is observed, the following 
reasons must be considered: (1) the diagnosis of iron deficiency anemia 
was incorrect; (2) blood loss is continuing at a rate greater than hemo- 
globin regeneration; (3) superimposed infection, malignancy, inflammation, 
or uremia prevent utilization of iron in hemoglobin synthesis; (4) the patient 
is failing to take the iron medication as directed; (5) absorption of the orally 
administered iron is defective. (Brown, E. B. Jr., The Management of Iron 
Deficiency Anemia: GP, XVII : 87-94, February 1958) 

:{:;{:>(: ^ 9{c 4c 

Farmer's Lung 

A disease entity of considerable importance to agricultural workers, 
particularly to those engaged in dairy farming, has received but scant atten- 
tion in the American literature. La Great Britain and Scandinavia, the ill- 
ness has been described variously as "farmer's lung, •' "thresher's lung, " 
"harvester's lung, " "bronchomycosis feniseciorum, " a form of lung mycosis, 
and as a pneumoconiosis. Finally, "hemp disease, " as reported in Norway, 
would appear to be similar to these other entities. 

Twenty-seven cases have been collected, some of which have been 
followed up to 6 years. Recent follow-up examination has been carried out 
to evaluate the presence of complications and permanent disability. As in 
most disease processes, gradations in severity occurred, but questionable 
variations of the syndrome have been excluded as have all cases representing 
the more commonly known manifestations of allergy. 

The syndrome develops after exposure to dusts which are usually 
moldy and most often associated with the handling of moldy hay or silage. 
Moldy grains were occasionally indicted, and even plain silage was not 
infrequently at favilt. Symptoms in a few followed inhalation of the "steam" 
of silage, but this occurred weeks after ensiling, on "opening" the silo and, 
therefore, would not likely be due to nitrous dioxide, the agent believed 
responsible for silo~filler's disease as recently described by Delaney, 
Schmidt, and Stroebel, and by Lowry and Schuman, 

Shredded corn stalks and dust from fresh hay and grain were also 
responsible for some cases despite repeated denial of any element of assoc- 
iated mold. Following the first attack, most cases reported recurrent symp- 
toms after exposure not only to the original offending agent, but to a wide 
variety of the dusts mentioned which strongly suggests a broad cross sen- 
sitization. 

A minor form of the disease apparently occurs, causing dyspnea, 
chills and fever, and night sweats lasting a day or two after exposure to 
clouds of dust associated with threshing fretfh grain. The symptoms pass 
quickly and the few cases seen complained of no permanent disability. None 
are included in this series. 



Medical News Letter, Vol, 31, No. 5 



Despite variation in severity, a typical acute episode following expos- 
ure to the causative agent is characterized by increasing dyspnea, cough 
which is usually nonproductive, fever and chills, night sweats, and weight 
lo a a . 

Dyspnea occurred in every case. Although mild to moderate in a few, 
in most it was the major difficulty, not infrequently associated with cyanosis, 
and in several requiring admini at ration of oxygen. The weight loss was 
severe when it occurred, varying from 5 to 65 pounds and averaging 29 
poxinds. A few patients complained of fatigue, muscle aching, headache, or 
jchest pain; three patients stressed the terrible odor of the drenching sweats 
they experienced. Seventeen patients were hospitalized at some time during 
the course of illness. 

Despite recovery after a variable period of weeks, the patient com- 
plained frequently of permanent limitation of exertional capacity. Following 
the initial attack, later exposure to the inciting agent, or to one of a variety 
of such agents, precipitated recurrence of synnptoms — particularly dyspnea. 
In some, exposure to even the spore laden barn air maybe responsible for 
such recurrence. 

After repeated episodes, progressive disability occurred with pulmon- 
ary emphysema, fibrosis, and right sided heart strain. These patients 
almost invariably complained of recurrent seasonal "colds*" or "fiillness" 
in the chest on exposure to dusts which usually were caused by handling 
moldy hay or silage. In all cases, the symptoms were far worse in the 
winter than in the summer. 

The onset of the disease followed three clinical patterns, and the 
patients were almost evenly divided between these groups: 

Group I (11 cases ). These constituted the most spectacular cases with 
the acute attack following a single exposure to unusual quantities of the 
inciting agent which was severely moldy hay, grain, or silage in all but 
one caae. The exception was exposed to silage "steam" on opening the 
silo. 

Group II (9 cases ). Symptoms occurred following repeated exposure 
to unusually moldy hay, grain, or silage over a period of time — usually 
a winter season — with constant handling of the material. In only one 
case was exposure to moldy dust denied, this by a farmer repeatedly 
exposed to fine particulate matter produced by grinding hay in a hammer- 
mill for feed. All other cases stressed the unusual moldy quality of the 
material for that particular year. 

Group III (7 cases }. These patients complained of symptoms of a 
variable degree of severity following exposure to different inciting agents 
over a period of years. The severe acute exacerbation then occurred 
without any one particularly outstanding episode of exposure. Interestingly, 
these patients were concerned mostly with apparent sensitization to corn 
silage rather than to moldy hay. 



8 Medical News Letter, Vol. 31, No. 5 



Two fundamental reactions are considered to be involved in the dis- 
ease process: There is an initial pulmonary response to inhalation of orgcui- 
ic dusts involving a granulomatous reaction with associated interstitial 
fibrosis; Liater sensitization to such dusts is believed to occur and there Is 
progressive pxilmonary fibrosis on repeated exposures. 

Some permanent pulnaonary disability may follow the ixdtial attack, 
and increasingly severe disability is certain to take place on repeated expos- 
ure once sensitization has occurred. 

The dusts involved are most often due to severely moldy hay, grain, 
or silage, and the heavy fungal spore content of such dusts is believed to be 
largely responsible for the disease, although the syndrome is rarely due 
to vegetable dusts which are not significantly moldy. The pulmonary reac- 
tion to the fvuigal spores is due to their action as inhaled foreign material 
and the disease is not believed to represent a pulmonary infection or mycosis. 

In the majority of cases, developing the disease — even if only a single 
attack — a change of occupation should be strongly recommended. Preven- 
tive measures should be advocated widely in an effort to save the individual 
farmer from developing an economically disastrous disease. 

A great deal is as yet unknown regarding the causation and mode of 
progression of farmer's lung, but present knowledge would seem to warrant 
regarding it as a form of pneumoconiosis due to organic dust. {Frank, R. C. , 
Farmer's Lung - A Form of Pneumoconiosis Due to Organic Dusts: Am. 
J. Roentgenol., 79: 189-213, February 1958) 

99c 3p ^ fp 3p ^ 

Staphylococci 

Unlike the situation in virtually every other human- infection caused 
by cocci, there is now no clearly described best antimicrobial therapy for 
penicillin- resistant staphylococcal infections. This report is concerned 
with in vitro studies upon staphylococcal growth as inhibited by eight anti- 
microbial agents used singly and in various combinations and with observa- 
tions made in the managenient of 60 cases of serious staphylococcal infec- 
tions in adults. 

Staphylococci are ubiquitous — all are constantly exposed to high numbers 
of them. Although epidemiologic studies about infections caused by them are 
important, it is reasonably clear that infection can be determined by a variety 
of events not necessarily related to source nor to the biologic characteristics 
of the strain itself. There is no doubt that a number of apparently healthy 
people develop serious staphylococcal infections spontaneously, and that its 
occurrence in this setting does not diminish the over all intensity of the infec- 
tion or its outcome. In the present series, for example, the worst and most 
fulminating infections developed in patients prior to hospital admission. Of the 



Medical News Letter, Vol. 31, No. 5 



29 cases of septicemia, 17 -were established when the patient was hospital- 
ized; 10 of these died. 

Serious staphylococcal infections, however are most commonly 
observed in patients with some chronic underlying disease process. Pre- 
sumably, such individuals carrying or exposed to others carrying staphy- 
lococci may develop an abscess and svib sequent bacteremia as a result of 
some break in body defenses initiated perhaps because of a deteriorating 
or spreading underlying illness, or because of trauma or a manip\ilative 
procedure. 

Or the opposite may obtain; a minor or latent infection may produce 
a worsening of the patients' underlying diseasej thereafter, the infection 
becomes clinically more serious. Age by itself is not an important deter- 
minant to infection For instance, in the present series of 60 cases, 23 were 
under 45 years of age (13 in 29 cases of sepsis). It must be emphasized 
also that penicillin- resistant strains are not always isolated solely from 
hospital acquired infections. They are the cause of infections in persons 
without prior hospital experience; in this study, 25 of 30 strains isolated 
from patients whose infection developed prior to admission were resistant 
to penicillin. Conversely, not all hospital acquired infections are caused 
by resistant strains; 8 of the 30 in the present series were sensitive. 

The development of a localized infection generally precedes dissemina- 
tion and sepsis, but this sequence is not always clinically evident; occasion- 
ally, the first lesion is small and/or transient and may be overlooked. 

There is another significant feature in clinical infections caused by 
staphylococci whichwas commoninboth groups of patients. The vast majority 
of individuals, prior to the staphylococcal infection, had been receiving one 
or more antimicrobial agents for a variety of indications, such as another 
infection or for prophylactic reasons. Twenty-nine of the 30 patients 
whose infection developed while in the hospital were receiving them when 
the staphylococcal infection supervened; 10 of 30 who came to the hospital 
with the infection already established had similarly received drugs immed- 
iately preceding the infection. Presumably, such therapy had altered their 
standard bacterial flora and the change may have added to opport\uiities for 
invasion and superinfection by staphylococci. This facet of staphylococcal 
infections deserves more detailed study. 

In the present series of 60 cases, a combination of erythromycin and 
chlormaphenicol was used as the niajor regimen in 43, including 6 of the 13 
cases caused by penicillin- susceptible strains. Treatment of the remaining 
cases was extremely varied with penicillin and streptomycin, plus one or 
more other agents, being the common prescription. 

This report describes laboratory methods designed to demonstrate 
the efficacy of a substitute for penicillin, and clinical experiences with the 
best of the substitutions so far observed. Although hardly comparable with 
respect to numbers of organisms killedandthe speed of killing, erythromycin 



10 Medical News Letter, Vol. 31, No. 5 



eind chloramphenicol in combined large dosage have proved to be an effec- 
tive combination to control growth of penicillin- resistant organisms. These 
two — with perhaps bacitracin for a few days— have proved to be as effective 
a combination in therapy of hunnan infections as has been described. No 
other single drug or combination of drugs (antimicrobial therapy) has been 
shown to be better — consistently, at any rate. 

The authors' impression both in vitro and in vivo is that staphylococci 
whose resistance to penicillin is greater than 0, 15 u/ml. produce penicillin- 
ase and are for practical purposes penicillin- resistant. Penicillin in clin- 
ical therapy is useless in infections caused by those strains of staphylococci. 
Similarly, other single drug therapy has resulted in increasing numbers of 
strains of staphylococci resistant to multiple other agents. In such circum- 
stances also, the agent is of no clinical value. 

Regardless of the importance of the epidemiologic aspects of penicillin 
resistant staphylococci, it cannot be concluded that the infection hits only 
old persons in the hospital whose adn:iission was necessitated by some other 
debilitating noninfectious disease. Although iincommonly seen in a setting 
of good health, penicillin -resistant staphylococcal infections occur at all 
ages, in patients well removed from exposure to hospital personnel, and 
without known experience to a contaminated source. They do, however, 
probably occur more often in patients receiving antibiotics for some non- 
specific "prophylactic" reasons than in patients not so "protected. " 

Energetic, but not unreasonably radical, therapy tor disseminated 
penicillin-resistant staphylococcal infections is indicated. A significant 
reduction in mortality is anticipated, although the lowering is not so great 
as had been hoped. To date, no agent or combination of agents is as effi- 
cacious as penicillin was in the era when the nraajority of isolated strains 
were sensitive to it. Adjuvant therapy is essential if there is localization 
of the infection; with pus, particularly, surgical drainage^ is reqviired. 
(Bunn, P, , et al. , Staphylocci - On the Ubiquitous Nature of Human Infec- 
tions and Their Control by Antimicrobial Agents, Singly, or in Combination: 
Ann. Int. Med., 48: 102-111, January 1958) (Refer: Medical News Letter, 
Vol. 30, No. 4. Page 17, 23 August 1957, and: Vol. 31, No. 4, Page 13, 
21 February 1958) 

>}c ife ste ?fe ?k A 

Sympathectomy for Raynaud's Phenomenon 

In this report, the results of surgical sympathectomy are evaluated 
in 70 women with Raynaud's disease in whom adequate follow-up informa- 
tion exists, ajid in 54 women with secondary Raynaud's phenomenon. 

The diagnosis of Raynaud's disease was -established either preopera- 
tively or postoperatively in all cases by reference to the criteria of Allen 
and Brown. Stated briefly, these criteria are (1) episodes of Raynaud's 



Medical News Letter, Vol. 31, No. 5 11 



phenomenon excited by cold or emotion; (2) bilaterality of Raynaud's phen- 
omenon; (3) absence of gangrene, or if present, ita limitation to minimal 
grades of cutaneous gangrene; (4) absence of any other primary disease that 
might be causal, such as occlusive arterial disease, acrosclerosis, cervi- 
cal rib, or orgajiic disease of the nervous system, and (5) symptoms for at 
least 2 years. Cases of secondary Raynaud's phenomenon were carefully 
excluded. 

Follow-up data were obtained by questionnaire, by reexamination at 
the clinic, or both. 

Ninety-three percent of the patients were less than 40 years old and 
70% were less than 30 years old when symptoms of Raynaud's disease were 
first noted. Seventy-three percent were less than 40 years of age when 
sympathectomiy was undertaken. The shortest duration of Raynaud's phen- 
omenon at time of sympathectomy was 1 year for 3 patients, and the longest 
duration of symptoms before operation was 23 years for 1 patient. The 
mean duration of symptoms before operation was 7 years. Eighty-one 
percent had had symptoms for 10 years or less. Six patients were operated 
on less than 2 years after onset of symptonis, but for all, follow-up data were 
more than adequate to satisfy the fifth criterion of Allen and Brown. 

Raynaud's phenomenon occurred in the fingers of both hands of all 70 
patients. Fifty-one patients noted vasomotor phenomena in the toes also, 
and the nose of one was similarly affected. Exposure to cold wag the only 
precipitating factor for Raynaud's phenomenon cited by 46 women. The 
rennaining 24 stated that emotional reactions as well as exposure to cold 
were responsible. Only 2 patients gave a family history of Raynaud's disease. 

Thirteen of the 70 patients were sufficiently troubled by various func- 
tional and neurotic symptoms (exclusive of migraine headache) to warrant 
their inclusion among the final diagnoses. Ten patients had migraine head- 
aches, and 2 had arterial hypertension (greater than 150 mm. Hg systolic 
and 90 mm. Hg diastolic). 

Eighty-nine operations to interrupt sympathetic nervous pathways 
were performed on the 70 women with Raynaud's disease and the types of 
procedure employed are listed by table. Sympathectomy was performed on 
52 women for the upper extremities only, for the lower extremities only for 
2 women, and for both the upper and the lower extremities for 16 women. 
More extensive ganglionectomy was performed on 2 women who had obtained 
no relief from earlier ganglionectomy. Each is included as only 1 operation 
in. a second table. Three women underwent cervicothoracic ganglionectomy 
after resection of the thoracic trunk had failed to give relief. Only the final 
result for each patient is included in subsequent tables. Bilateral procedures 
were considered and evaluated as one operation because in most cases the 
responses between paired denervated extremities did not vary appreciably. 

The cervicothoracic ganglionectomy of Adson consists of the extirpa- 
tion of the stellate ganglion and, usually but not always, of the second thoracic 



12 Medical News Letter, Vol. 31, No. 5 



sympathetic ganglion through a posterior approach. It is a postganglionic 
sympathectomy. Resection of the thoracic trunk, proposed independently 
by Smithwick and Telford consists of dividing the sympathetic chain between 
the third and fourth thoracic ganglia and dividing the rami to the second 
and third ganglia. The second and third thoracic nerves are divided prox- 
imal to the sensory root ganglia. No ganglia are removed and hence this 
is a preganglionic sympathectomy. The anterior rhizotomy performed for 
1 patient was a variation of the preganglionic sympathectomy. 

The period of postoperative follow-up for these 70 women varied from 
1 to 28 years; the mean was 12 years. The mean period of follow-up after 
cervicothoracic sympathectomy was 11 years, and after lumbar sympath- 
ectomy, 14 years. 

In addition to the 70 women with Raynaud's disease, 54 women with 
Raynaud's phenomenon secondary to other diseases were also subjected 
to sympathectomy of the upper or lower extremities or both, prior to 1946. 
The diagnoses included acrosclerosis (37 patients), rheumatoid arthritis 
(5 patients), livedo reticularis or acrocyanosis (5 patients), chrome occlu- 
sive arterial disease (2 patients), and chronic pernio, periarteritis nodosa, 
scalenus anticus syndrome, indeterminate hemorrhagic diathesis, and 
indeterminate disease of the central nervous system (1 patient each). 
Sympathectomy, although giving better results in the lower than in the upper 
extren:iities, was successful much less frequently than in primary Raynaud's 
disease. The majority of good or excellent results were obtained in the 
patients with acrocyanosis, livedo reticularis, scalenus anticus syndrome, 
and chronic pernio. Sympathectomy was followed by major or minor am- 
putations in 6 patients in this group. Nineteen (35%) of the women with 
secondary Raynaud's phenomenon were dead at the time of follow-up. The 
average age at death was 39 years. 

Errors in the diagnosis of Raynaud's disease will lead to disappoint- 
ing results from sympathectomy because Raynaud's phenomenon secondary 
to other diseases (notably acrosclerosis) usually responds poorly to sym- 
pathectomy. 

Sympathectomy for Raynaud's disease affecting the upper extrenriities 
gave good or excellent results in 37 (54%) of 68 women in this series. Good 
or excellent results were obtained more frequently if complications of 
Raynaud's disease (trophic lesions or sclerodactylia or both) were not 
present before operation. There was no significant difference between the 
results obtained by preganglionic and postganglionic sympathectomies. 
Two (3%) of the 68 patients lost portions of fingers after sympathectomy. 
Of the patients who had a fair or poor long-term result, the majority initially 
obtained a good result and then had relapses during the first 2 years after 
sympathectomy. 

Sympathectomy for the lower extremities gave good or excellent 
results for 17 (94%) of 18 women with Raynaud's disease. Sympathectomy 



Medical News Letter, Vol. 31, No. 5 13 



for Raynaud's phenomenon secondary to other diseases gave poor results 
in the upper extremities in 72% of cases and only slightly better results in 
the lower extremities. 

Synn pa thee torn y should be reserved for patients with the more severe 
and progressive Raynaud's disease, because the prognosis is good without 
sympathectomy when the disease is mild or moderately severe and not 
progressing. (Gifford, R. W. Jr. , Hines E. A. Jr. , Craig, W. McK. , 
Sympathectomy for Raynaud's Phenomenon - Follow -Up Study of 70 Women 
with Raynaud's Disease and 54 Women with Secondary Raynaud's Phenome- 
non: Circulation, XVII: 5-12, January 1958) 

sEc ik ik sAc sk sfe 

Buckling of the Aortic Arch 

Since the first report of buckling of the aortic arch by Souders et al. , 
in 1951, occasional reports have appeared in the literature substantiating 
their observations and more firmly establishing this anomaly as a distinct 
anatomic and roentgenographic entity. Because most of these reports have 
appeared in nonradiologic literature and recognition and understanding of 
the roentgenographic appearance is not generally appreciated, it seems 
warranted to report four such cases seen by the author. In all, perhaps 
fewer than 35 cases have been referred to in the Englrsh literature. 

In essence, one is speaking of an anomalous buckling or kinking in 
the contour of the aortic arch, located at the usual site of insertion of the 
ligamentum arteriosum. The abnornrial aortic contour thereby produced 
may simulate aortic coarctation, aneurysm, or mediastinal tumor and may 
result in unnecessary surgery, radiation therapy, or angiocardiography. 
Each of these errors of diagnosis is described. 

The buckling or kinking in all reported cases occurred at the aortic 
isthmus in the region of insertion of the ligamentum arteriosum. Where 
accurate observations have been made, the ligamentum is reported to be 
unusually short. Due to, or coupled with, the short ligamentum is a 
posteriorly directed double convexity of the aortic arch and upper descend- 
ing aorta centered about the point of fixation of the aorta. The portion of 
the arch above the kink generally extends higher into the superior media- 
stinum than usual, then descends to the point of the kink, deviates abruptly 
posteriorly and to the left, then descends to the right. There is no regular- 
ity, however, of the exact aortic course in the reported cases. It should 
be stressed that the buckling described produces no significant reduction 
in the aortic lumen. 

The postero -anterior view nearly always provides the initial clue to 
aortic buckling. In this projection, one sees in the shadow of the descend- 
ing arch an indentation produced by the profile of the anomaly. In some 



14 Medical News Letter, Vol. 31, No. 5 



instances, the appearance is only that of a gene reus -sized aortic "knob" 
with an abrupt indentation at its inferior pole and a second convexity in 
the descending arch below this point. Others present a double convex con- 
tour of the "knob" with the superior of the two convexities less dense than 
the inferior. The upper density is produced by the portion of the arch 
proximal to the kink, while the lower represents the devious aortic course 
just distal to the anomaly. At times, the upper arch is largely obscured by 
the thoracic vertebrae and the lower convexity sinnulates an inferiorly dis- 
placed knob. It is the portion of the arch distal to the kink which produces 
an indentation on the barium-filled esophagus in such cases. While it is the 
postero-anterior view which suggests the diagnosis, it is the lateral or left 
anterior oblique view which generally confirms the suspicion. In the latter 
projections, one can identify the abrupt indentation on the posterior eind left 
lateral surface of the aorta at the expected level of ligamentum arteriosum 
insertion. If any significant difference exists in the aortic diameter prox- 
imal and distal to the anomaly, it is the distal portion which may be slightly 
dilated. 

Aortic buckling is a rare congenital anomaly of the course and contour 
of the aortic arch occurring at the level of insertion of the ligamentum ar- 
teriosum. It is probably associated with, or is perhaps due to, a short 
ligamentum arteriosum. 

A typical roentgenographic appearance is presented which must be 
differentiated from aortic aneurysm, coarctation, mediastinal tumor, and 
patent ductus arteriosus, Postero-anterior and lateral roentgenograms 
with lateral planigrams will provide proof of the diagnosis in most cases. 
Angiocardiography or retrograde aortography may be utilized if further 
clarification is necessary. Roentgenographic evidence of buckling is accen- 
tuated by the degenerative changes of senescence. 

A precordial systolic murmur is the only associated objective finding. 
The patients are asymptomatic and need no treatment. (Stevens, G, M. , 
Buckling of the Aortic Arch (Pseudocoarctation, Kinking) - A Roentgeno- 
graphic Entity: Radiology, 70: 67-73, January 1958) 

3;c »fc ^ :^ :^ ^ 

Liver Biopsy 

Most authorities agree that the discriminative use of needle biopsy 
of the liver outweighs its dangers, and in experienced hands with proper 
precautions, the risk to the patient is almost negligible. The number of 
excellent reports on liver biopsy that have appeared in recent years under- 
line the increasing importance of this procedure and its contribution to 
the study of liver disease. So far, it has had its widest application clin- 
ically and has become one of the main diagnostic tools in the differential 



Medical Newa Letter, Vol. 31, No. 5 15 



diagnosis of a wide range of liver diseases. Zanncheck and Sidman have 
recently listed a number of other diseases not primarily hepatic in origin 
in which liver biopsy has been usefully employed. These include such varied 
conditions as amyloidosis; Wilson's disease; hemochroniatosis; syphilitic 
cirrhosis; cardiac cirrhosis; granulomatous diseases, such as leprosy, 
brucellosis, sarcoid, and fungus infections; inflammatory diseases, such 
as infectious mononucleosis, Weil's disease, and toxic hepatitis from cin- 
cophen, chloroform, and arsenic poisoning; certain focal necroses, such 
as tularemia, syphilis, liver abscess (both bacterial and amebic), peri- 
arteritis nodosa, lupus erythematosus, leukemia, Hodgkin's disease, and 
a number of parasitic diseases, such as kala-azar and schistoson^iasis. 
Its potentialities for basic histopathological and chemical research are also 
increasingly recognized and the indications for its use are now well defined. 

With the opening of the University College Hospital of the West Indies 
in September 1952, it soon became evident that a number of conditions were 
occurring locally in which a detailed knowledge of the histological and bio- 
chemical changes in the liver would be of value. Some of these— -kwashior- 
kor, nnarasmus, and sickle -cell anemia— occur in other tropical countries 
and have been the subjects of many previous reports. Others, however, 
such as veno -occlusive disease of the liver and the vomiting sickness of 
Jamaica, had not been reported from other areas and detailed clinical, his- 
tological, and biochemical studies of the associated hepatic changes had not 
been previously undertaken. In the study of these conditions, liver biopsy 
was used with particular advantage (1) as a clinical tool — especially when 
serially performed — in establishing the clinical diagnosis; in following the 
course of the disease and in assessing prognosis and response to treatment; 
and (2) as an investigative procedure in determining the type, duration, and 
severity of the pathological and biochemical changes in a number of cases 
in which the clinical diagnosis was not in doubt. In this article are given 
(1) a clinical outline of some less widely known diseases which have been 
studied by liver biopsy — veno-occlusive disease of the liver, kwashiorkor, 
marasmus, and the condition which has been known in Jamaica for many 
years as "vomiting sickness;" (2) the histopathological and biochemical 
information obtained from liver biopsy in these conditions and its unique 
contribution to present Tinder standing of them; (3) the advantages of simul- 
taneous histopathological and chemical examination of portions of the tissue 
obtained at biopsy; (4) the authors' experience with liver biopsy in some of 
the more familiar clinical circumstances, such as unexplained hepatomegaly, 
splenomegaly, and jaundice. The liver-biopsy findings in sickle-cell anemia, 
nephrosis, diabetes, a neuropathic syndrome probably nutritional recently 
reported from Jamaica, and other miscellaneous conditions are also des- 
cribed. 

Five hundred twenty- seven biopsies were performed on 330 patients. 
The conditions studied included kwashiorkor, marasmus, verio-occlusive 



16 Medical News Letter, Vol. 31, Np. 5 



disease of the liver, vomiting sickness, diabetes mellitus, various neuro- 
pathies, nephrosis, sickle-cell anemia, and unexplained hepatomegaly, 
splenomegaly, jaundice, pyrexia, and anemia. 

A clinical outline is given of veno-occlusive disease, kwashiorkor, 
marasmus, and the vomiting sickness of Jamaica. The tissue obtained 
at biopsy was examined histologically in all cases. In a number of cases, 
chemical examination of the liver tissue was also performed. The chemical 
studies included nucleic acids and protein, water, and fat content, and gly- 
cogen estimations. 

In the malnutrition group, it is shown (a) that the degree of fatty infil- 
tration is no indication of the severity or probable outcome of the disease; 
(b) that hepatic protein depletion is severe in these infants, but that its 
degree cannot be quantitatively correlated with the clinical picture or prog- 
nosis; and (c) that fatty infiltration does not apparently interfere with the 
ability of the liver to store glycogen. 

Occlusion of the smaller and medium-sized branches of the hepatic 
veins is responsible for the hepatomegaly and ascites found clinically in 
veno-occlusive disease. The prognosis of veno-occlusive disease is 
linked with the severity of the associated hepatocellular damage. 

Serial biopsies have made it possible to define more accurately the 
clinical natural history of this disease. In cases that recover, the his- 
tological appearances of the liver return to normal. When the disease ad- 
vances to the chronic stage, a progressive nonportal cirrhosis is found to 
develop in biopsy specimens. 

The histological changes of the liver in diabetes are minimal and 
cannot be correlated with the response to treatment, clinical hepatomegaly, 
or alteration of liver -function tests. 

The hypoglycemia of vomiting sickness is associates with severe 
depletion of hepatic glycogen which is rapidly restored by successful glucose 
therapy. There is a high incidence of fibrosis of the liver in patients with 
sickle -cell anemia, and a possible etiologic relationship is suggested. 

Because of the frequently mixed nature of hepatic cirrhosis in the 
tropics and the variability of the clinical syndromes presented, liver biopsy 
is a useful and often essential tool for establishing a correct diagnosis. Its 
uses in unexplained hepatomegaly, jaundice, and splenomegaly have also 
been demonstrated. It is also pointed out that liver biopsy often makes it 
necessary to aiter-an apparently firmly established clinical diagnosis. 

The advantages of simultsineous histopathological and chemical exam- 
ination of portions of the tissue obtained at biopsy are stressed. (Stuart, K. L. , 
et al. , Further Clinical and Investigative Uses of Liver Biopsy: Arch. Int. 
Med., 101:67-81, January 1958) 

j^ 3^ ;^ :{( 9(c :{: 



Medical News Letter, Vol. 31, No. 5 1? 



Supervoltage Therapy in Cancer of the Bladder 

Much has been written in regard to various types of irradiation for 
carcinoma of the urinary bladder. Most of these reports and studies have 
been concerned with the interstitial use of radium or radon and conventional 
x-ray therapy. Most authorities have agreed on the inadequacies of this 
kind of therapy for many cases of carcinoma of the bladder. With the avail- 
ability of supervoltage, it was felt that the problem of irradiation of bladder 
carcinoma should be reevaluated. 

All patients with carcinoma of the bladder seen in the Urology Depart- 
ment at M.D. Anderson Hospital, Houston, Texas, were evaluated with the 
Radiotherapy Department for disposition. Since April 1954, the emphasis 
has been directed towards radical irradiation with supervoltage. Except 
for those cases with superficial low grade carcinoma which were handled 
Iransurethrally, irradiation was given precedence over other forms of sur- 
gical procedure. The majority of patients were referred to a state cancer 
hospital and, therefore, included failures of other types of treatment. In 
addition, many patients in this group have been referred directly to the 
Radiation Therapy Department by private urologists in and near Houston. 
Since the progrann of supervoltage radiation of bladder carcinonoa was 
started, the authors have treated by external irradiation with supervoltage 
Sonne lesions which otherwise co\ild have been treated with interstitial or 
intracavitary irradiation. 

In planning the treatment, the aim has been to treat the empty whole 
bladder. The authors' decision to treat the whole bladder rather than a 
part of it, and to prefer external irradiation in cases which could have been 
handled by intersitital or intracavitary irradiation has been influenced by 
Roger Baker's demonstration of circumferential lymphatic spread of cancer 
cells along the muscle wall. In whole-organ studies of infiltrating carci- 
noma of the bladder, this author found presence of malignant cells in the 
lynnphatLcs of the bladder wall. In some cases, over 50% of the bladder 
circumference was involved— well beyond the limits of the visible and 
palpable disease. As Baker pointed out, these findings require a more 
radical surgical approach to bladder cancer and from the authors' stand- 
point they reqmre nnore radical irradiation. 

The advantages of the supervoltage over the traditional standard x-ray 
therapy are well known. The greater depth dose and the skin-sparing effect 
permit one to obtain a large tumor dose in deep-seated tumors with min- 
imal skin reactions. The general tolerance of patients to this type of ther- 
apy is greatly improved. It is particularly striking in supervoltage irradia- 
tion of the urinary bladder that the local reaction and urinary symptoms are 
definitely milder than in cases treated with conventional therapy. This allows 
more satisfactory treatment without interruption due to severe symptoma- 
tology of the patient and reduces considerably the complications following 
radiation therapy. 



18 Medical News Letter, Vol. 31, No. 5 



All of the authors' cases were treated with either the cobalt-60 irrad- 
iator or with the betatron. In the first year, the patients were alternated 
between the two machines with the aim of finding whether there were dif- 
ferences in the tolerance reactions and immediate results. These factors 
were found to be fairly equal in both series; recently, therefore, preference 
has been given to the use of betatron in irradiation of cancer of the bladder 
because of better volume distribution. The use of the betatron has avoided 
the late fibrosis of the subcutaneous tissue in the suprapubic region which 
has occurred in some cases treated with cobalt-60. The authors now re- 
serve the use of the cobalt-60 almost exclusively to those cases in which 
there is an involvement of the anterior wall of the bladder with extension 
into the prevesical space. 

The modality of the radical treatment has been uniform. The whole 
bladder has been treated to a minimal tumor dose of 6000 roentgens in five 
weeks using a three-field arrangement. 

All cases were followed with cystoscopies at varying intervals. In 
the earlier cases, a cystoscopy was performed one week after completion 
of the treatment to study the immediate bladder reaction and to further 
check the accuracy of the localization. This reaction consisted of a diffuse 
erythema of the bladder n^ucosa with pseudomencibrane formation and bullous 
edema, especially surrounding the area of the tumor. This type of reaction 
was found consistently in all cases. The cystoscopies since then have usually 
been performed at one, three, six, and twelve-month intervals. 

So far, the following impressions can be drawn from the authors' 
material and experience: 

Patients with disease extending to the pelvic wall and patients with less 
extensive disease, but in poor general condition, are better treated with a 
palliative technique. Patients in these groups treated radically with high 
doses tolerate the treatnnent poorly and have more complications. 

Previous irradiation of any type is a limiting factor in the use of x-ray 
treatment. There appears to be a definite relationship between recent supra- 
pubic bladder surgery (especially partial cystectomy) and contracted bladder 
following irradiation. Presence of bladder neck obstruction or severe cys- 
titis at the beginning of the treatment decreases the local tolerance to irrad- 
iation. Urinary diversion prior to irradiation nnay be essential in son^e 
cases. Women, especially in the older age groups, tolerate the treatment 
less satisfactorily. 

Bladder surgery following irradiation supported the well known fact 
that irradiated tissue shows diminished healing capacity. The analysis of 
the superficial low-grade group has shown that the potentiality of the bladder ■ 
mucosa to form new lesions is not eradicated by irradiation. Therefore, 
low grade, low stage lesions are probably best handled by transurethral 
surgery. 



Medical News Letter, Vol. 31, No. 5 19 



Recurrences that reveal increase In stage and/or grade, or lesions 
which cannot be adequately removed transurethrally can be eradicated by 
irradiation. High grade lesions, including undifferentiated and squamous 
carcinoma and lesions in stage B2 and C should be treated radically. Super- 
voltage therapy in this group has been very encouraging and it appears to 
have definite place in the management of carcinoma of the urinary bladder. 
(Cuccia, C. A. , Jones, S. , Crigler, CM., Clinical Impressions in 100 
Consecutive Cases of Carcinoma of the Urinary Bladder Treated by Super- 
voltage: J. Urol., 22:99-109, January 1958) 

Total Adrenalectomy 

Bilateral adrenalectonny has been carried out with Increasing frequency 
in recent years for the control of certain types of carcinoma and for other 
diseases. Today, there are an increasing number of patients with no adrenal 
glands or with atrophied, poorly functioning, or nonfunctioning adrenal 
glands who must imdergo oral operative procedures. 

The totally adrenalectomized patient is usually on a maintenance dose 
of corticosteroid. The specific drug and dosage varies with each patient. 
On the basis of experience v/ith totally adrenalectonnized patients under- 
going oral operative procedures, the authors' conclusion was reached that 
additional corticosteroid therapy must be provided to sufficiently cover the 
extra stress precipitated by the procedure as follows: 100 to 250 mg. cor- 
tisone by mouth in divided doses (in addition to the maintenance dose) during 
the preoperative 24-hour period and 100 to 300 mg. cortisone by mouth or 
hydrocortisone intravenously on the day of surgery. To err on the side 
of higher dosage is always wise. 

Dental procedures are usually — perhaps erroneously — accepted as 
minor procedures by both the dental and medical profession. The amount 
of strain placed on the stress mechanism of the body during dental care may 
have been greatly underestimated. 

Oral surgical operations must be performed on patients with varying 
degrees of adrenal insufficiency or failure which may result from such 
states as invasive or infectious adrenal disease; unilateral, bilateral, total, 
or subtotal adrenalectomy; or adrenal atrophy secondary to, or concomi- 
tant with, high prolonged corticosteroid therapy in such chronic diseases 
as rheunnatoid arthritis. 

Because the over all condition of each patient with adrenal insufficiency 
may differ considerably, it is not possible to plan for the routine manage- 
ment of all such patients with a rigid therapeutic regimen. The symptoms 
and signs of adrenal insvifficiency should be recognized as varied and num- 
erous. One or many of the following signs may be present in a given patient 



20 Medical News Letter, Vol. 31, No. 5 



as an indication of impending danger: (1) slight nausea or malaise only; 
(2) vomiting; (3) temperature which maybe acute and high — as high as 105 
degrees; (4) fall in blood pressure, gradual or sudden and even within the 
normal range of the patient; (5) increased pulse rate which may be gradual 
or sudden and even within the normal range of the patient; (6) derangement 
of fluid or electrolyte balance (decreased serunn sodium and, particularly, 
increased serum potassium); (7) hypoglycemia; (8) shock; or (9) lethargy. 

Because patients in whom bilateral adrenalectomy has been per- 
formed (after which oral surgical operations must follow) are relatively 
on the increase, the extraction of infected or potentially symptomatic teeth 
may be indicated routinely as a precautionary measure prior to total adrenal- 
ectomy. 

Fear and nervous tensions contribute greatly to stress. To assess 
this factor in dental patients is n^ost difficult, especially if their emotional 
history and physical actions while being treated are not well known to the 
dental operator. An intelligent patient is usually educated so that, if and 
when symptoms of adrenal insufficiency develop, he will ask for and take 
a supplementary dose of the drug. This is much like the training of diabetic 
patients with respect to insulin over-dosage. 

However, it is mandatory in treating these patients for the responsible 
physician, in close cooperation with the dentist, to calculate and adminis- 
ter sufficient corticosteroid therapy to cover stress resulting from the 
emotional strain of the dental procedure. This is imperative in order to 
avoid adrenal insufficiency or failure which may quickly and suddenly result 
in an extremely serious emergency. All patients of this type must have 
careful medical supervision before, during, and after surgery, (Piro, J. D. , 
Yandel, F. , Kutscher, A. H. , Oral Operative Procedures in the Presence 
of Total Adrenalectomy: J. Oral Surg., 16: 63-67, January 1958) 

sk jfe ^ jfe ife sfe 

Venereal Disease Seminar 

The Venereal Disease Branch, Communicable Disease Center, Public 
Health Service, Department of Health, Education, and ■NeUa.re has notified 
the Surgeon General of the Navy that the following venereal disease meetings 
will be held in Philadelphia Pa. 

May 12 and 13, 1958 - Annual Symposium on Recent Advances in the 
Study of Venereal Diseases. 

May 14 and 15, 1958 - Venereal Disease Seminar, 

Medical Department personnel in the Philadelphia area are invited 
to attend and participate in these senriinars. More information can be ob- 
tained through local health departments. (PrevMedDiv, BuMed) 

ij|f !3fc 5k >fe sfe A 



Medical News Letter, Vol. 31, No. 5 



21 



Poison Control Centers 



The general objective of a poison control center is tp minimize 
the damage from potentially toxic substances by inproving efforts at 
prevention and trealanent of poisoning. More specifically, the primary 
objective Is to make initial treatment (first aid) more prompt and 
effective. This is being accomplished by accimimulating knowledge of 
potentially toxic substances and by making this knowledge more readily 
available; by increasing the knowledge of the general and specific 
treatment measures required and by making resources for treatment 
readily and continuously available; and by stimulating research for 
specific antagonists or antidotes for the more common and dangerous 
chemicals. 

A second major objective is in the field of prevention. This is 
being accomplished by developing a better knowledge of the distribution 
and tjrpes of poisonings and circumstances iinder which the poison is 
likely to be taken; by interrupting the chain of circumstances that 
leads to poisoning; and by using all available community agencies and 
communication media for spreading information about poisoning. 

The National Clearinghouse for Poison Control Centers, United States 
Public Health Service, has provided this Bureau with an up-to-date list 
of Poison Control Centers now in operation, (October 1957) . 

It Is strongly urged that each medical activity abstract from the 
following list, the names, addresses, and phone numbers of the Poison 
Control Centers nearest to them. It would prove most useful to estab- 
lish liaison with these centers so that needed information can be ob- 
tained with the least delay in the event of an emergency. 



ALABAMA 

Birmingham 

University of Alabama Medical 

Center 
Stephen D. Palmer, M. D. 
Phone: 53-3531 

Florence 

Eliza Coffee Memorial Hospital 

Stanley I^lgs, M. D. 

Phone: AT 2-8321 



Tucson 

College of Pharmacy 
University of Arizona 
Virginia M. Cobb, M. D, 
Phone: MA ii.-8l8l 

CALIFORNIA 
Berkeley 

Herrick Memorial Hospital 
Mr. Wight 
Phone: Thomwall 5-0130 



ARIZONA 
Phoenix 

Maricopa County Medical Society 
Paul B. Jarrett, M. D. 
Phone: Alpine 8-8331 



Los Angeles 

University of California 

Medical Center 
Pere Mlnden, M. D, 
Phone: Bradshaw 2-8911 



E2 



Medical News Letter, Vol. 31, No. 5 



Los Angeles 

Children's Hospital Society 

of Los Angeles 
Ifrs. Claire Barton, R, N. 
Phone: Normandy A-2121 

Martinez 

Contra Costa County Hospital 
L. F« Girtman, M. D. 
Phone: ^5a^tinez 3080 

Oakland 

Alameda - Contra Costa Medical 

Association 
David Singman, M. D. 
Phone: Olympla 2-8171 

Oakland 

Children's Hospital of the East 

Bay 
Edith M, l^ers, M. D. 
Phone: Olyr^sic 2-1143 

Oakland 

Highland-Alameda County Hospital 

Walter Byei»s, M. D. 

Phone: Kellog 2-1122 

San Francisco 

Central Emergency Hospital 
Erwin Sage, M. D. 
Phone: Heinlock 1-2800 



San Mateo 

Community Hospital of San Jfeteo 

Arthur Lach, Mo D. 

Phone: Fireside 5-5721 

Santa Clara County 
Santa Clara County Hospital 
Milton Chatton, M. D. 
Phone: Cypress 3-0262 

San Rafael 

Marin General Hospital 

Phone: Glencourt 3-3110 

COLORADO 
Denver 
Department of Health and 

Hospitals 
David Cook, M. D, 
Phone: Tabor 5-1331 

CONIiECTICUT 
Stamford 

Stamford Hospital 
Angelo Masterangelo, M. D. 
Phone: Fireside 8-2681 

DELAWARE 

Wilmington 
Delaware Hospital 
Elmer F, Fantazier, M. D. 
Phone: Olympla 5-3389 



San Francisco 
Children' s Hospital 
George Bates, M, D. 
Phone: Bayview 1-1200 

San Jose 

San Jose Emergency First Aid 

Station 
Dwight Bis sell, M. D, 
Phone: Cypress 2-3141 

San Leandro 

Fainnount Hospital of Alaraeda 

Coxinty 
Phone: Elgin 1-8000 



DISTRICT OF OOLm^IA 
Washington 
Children's Hospital 
James W. Oberman, M. D. 
Phone: Dupont 7-4220, Ext. 250 

FLORIDA 

Daytona Beach 
Halifax District Hosp*ital 
Joel V. McCall, Jr., M. D. 
Phone: Clinton 2-5561 

Fort Lauderdale 

North Broward General Hospital 

John S. Fifer, M, D. 

Phone: Jackson 2~36ll 



Medical News Letter, Vol. 31, No. 5 



23 



Fort l^ers 

Lee County Hospital 

A. Lo\d.s Girasdin, Jr., M. D. 

Phone: Edison 2-1141 



Sarosota 

Sarosota Memorial Hospital 
Henry G. Morton, M, D. 
Phone: Ringling 6-8831 



Gainesville 

Alachiia General Hospital 
William Hadley, M. D. 
Fhone: Franklin 2-4-321 



Tallahassee 

Tallahassee Memorial Hospital 
George S. Palmer, M. Do 
Phone: 2-8060 



Jacksonville 
St. Vincent's Hospital 
Jo K. David, Jr., M. D. 
Phone: Evergreen 9-7761 



Tampa 

Taii^ia Municipal Hospital 
James M, San, M. D, 
Phone : 8-4321 



Lakeland 

Morrell Memorial Hospital 
William S. Johnson, M. D. 
Phone: Mutual 4-4211 



West Palm Beach 
Good Samaritan Hospital 
Lawrence R. Leviton, M. D. 
Phone: Temple 3-1741 



Miami 

Jackson Memorial Hospital 
George Lister, M. D, 
Phone: Franklin I-96II 

Ocala 

Munroe Memorial Hospital 
Harry M. EduEirds, M. D. 
Phone: Marion 2-4211 

Orlando 

Orange Memorial Hospital 
Charlotte Maguire, M. D. 
Phone: Orlando 3-5511 

Panama City 

Memorial Hospital of Bay 

County 
John J. Benton, M. D. 
Phone: Sunset 5-7411 

Pensacola 
Baptist Hospital 
Frank L. Debusk, M. D, 
Phone: Hemlock 8-5423 

St. Petersburg 

Florida Pediatric Society 

Mound Park Hospital 

Ed Shaeffer, M. D. 

Phone: Mound Park 5-1181 



GEORGIA 
Albany 

Phoebe Putney Memorial Hospital 
M. Sutton, M. D. 
Phone: Hemlock 6-3321 

ILLINOIS 
Chicago 
Mercy Hospital 
Joseph Christian, M. D. 
Phone: Victory 2-4700 

Effingham 

St, Anthony's Hospital 

Phone: 85O 

Evanston 

Evanston Hospital 
Phone: Greenleaf 5-2500 

Evanston 

St. Francis Hospital 

Fhone: Davis 8-2200 

Evanston 

Community Hospital 
Phone: University 4-9400 

Springfield 
ftemorial Hospital 
Phone: 2-3361 



24 



Medical News Letter, Vol. 31, No. 5 



Springfield 

St, John' s Hospital 

Phone ! 2-6881 

'iNDIAUA 

Indianapolis 
Poison Control Center 
Irving Rosenbaum, M. D. 
Phone: Walnut 5-1677 

IOWA 

Des Moines 

Iowa Poison Information 

Center 
Everett A. Nitzke, M, D. 

KANSAS 
Topeka 

Stomiont-Vail Hospital 
William H, Crouch, M. D, 
Phone: Topeka 5-2361, Ext. 218 

KENTUCKY 

Louisville 

Louisville General Hospital 
William Curtis Adams, M. D. 
Phone: Juniper 2-1831 

LOUISIANA 

New Orleans 

Lotiisiana State University 

School of ffedicine 
Charles S. Petty, M. D. 

MARYLAND 
Baltimore 

Baltimore City Hospital 
Phone: Dickens 2-54-00 

Baltimore 

Johns Hopkins Hospital 
Julian Chisholm, M. D. 
Phone: ORleans 5-5500 

Baltimore 

University of Maryland 

Hospital 
Samuel Bessman, M. D. 
Phone; Lexington 9-0320 



MASSACHUSETTS 
Boston 

Children's Medical Center 
Robert J, Haggerty, M.. D. 
Phone: Beacon 2-7800 

New Bedford 

St. Luke's Hospital 

William Collins, M. D» 

Phone: Wymati 9-6211, Ext, 359 

Worcester 

Worcester City Hospital 
Robert D. Cox, M. D,, 
Phone; Pleasant 6-1551 

MICHIGAN 
Detroit 

Herman Kiefer Hospital 
Paul T. Salchow, Mo D. 
Phone: Trinity 2-333A 

Grand Rapids 
Butterworth Hospitail 
Mark W. Dick, M. D. 
Phone: Glendale 1-3591 

Grand Rapids 

Blodgett Memorial Hospital 
John Jfontgomery, M, D, 
Phone: Glendale 6-5301 

Grand Rapids 
St. Mary's Hospital 
0. E. Booher, M. D. 
Phone: Glendale 9-3131 

Pontiac 

St. Joseph Mercy Hospital 
Robert J. Mason, M. D. 
Phone: Federal 4--3511 

MINNESOTA 

Minneapolis 

Minnesota State Department of 

Health 
Warren Lawson, M» D, 
Phone: Federal 9-7751 



Medical News Letter, Vol. 31, No. 5 



25 



MISSOURI 

Kansas City 

Kansas City General Hospital #1 

Beryl I. Burns, M. D. 

Phone: Harrison I-8O6O 

Kansas City 
Mercy Hospital 
Wayne Hart, M. D. 
Phone: Grand 1-5250 

St« Louis 

St» Louis Children's Hospital 
J. No Middelkamp, M. D. 
Phone: Forest 7-6880 

St. Louis 

Homer G. Phillips City Hospital 
J. N. MiddelkaiEp, M. D. 
Phone: Franklin 1-3100 

St. Louis 

St, Louis City Hospital 
Virginia Peden, M. D. 
Phone: Central 1-7300 

St. Louis 

Cardinal Glennon Memorial 

Hospital for Children 
James P. King, M. D. 
Phone: Mohawk A-7222 



Newark 

Babies Hospital 
William He Fost, M. D. 
Phone: Humbolt 2-6200 

Nutley 

The Nutley Child Safety Program 
William J. Farley, M. D, 
Phone: Nutley 2-0139 

South Orange 

Orange Memorial Hospital 
Robert E. Jennings, M. D» 
Phone: 5-1100 

HEW YORK 

New York City 

New York City Department of 

Health 
Harold Jacobziner, M. D. 
Phone: Worth 4-38OO, Ejct. 680 

Albany 

Albany Hospital 

Paul Patterson, M. D. 

Phone; Albany 8~J^5A1 

Buffalo 

Buffalo Children's Hospital 

Donal Dunphy, M, D. 

Phone: Summer 5-100, Ext. 2A2 



NEBRASKA 
Omaha 

Children's Memorial Hospital 
Phone: Glendale 54.00 



Rochester 

Strong Memorial Hospital 

Charles C. Lobeck, M, D, 

Phone: Greenfield 3-4400, Ext. 224 



NEW JERSEY 

Atlantic City 
Atlantic City Hospital 
Samuel C. Southard, M. D. 
Phone: Atlantic City 5-2112 

Long Branch 

Monmouth lytemorial Hospital 
Martin Rush, M. D. 
Phone: Capitol 2-5200 



Syracuse 
City Hospital 
Virginia Harris, M. D. 
Phone: Granite 6-3166 

NORTH CAROLINA 
Durham 

OPD, Duke University Hospital 
Jay Arena, M. D. 
Phone: Durham 9011, Ext, 398 



Montclair 

Mountainside Hospital 
Louis Pilloni, M, D. 
Phone: Pilgrim 6-6000 



OHIO 
Akron 

Children's Hospital 
Mr. P. A. Hoyden 
Phone: Blackstone 3-5531 



26 



Medical News Letter, Vol. 31, No. 5 



Cincinnati 

The Kettering Laboratory 
College of Ifedicine 
Mitchell R. Zavon, M, D, 
Phone: CA-lAl-i 

Cleveland 

Cleveland Academy of Medicine 
George Bedder, M. D<. 
Phone: Cedar 1-3500 

Columbus 

The Children's Hospital 
Warren E. Vjheeler, M. D. 
Phone: Clearbrook 8-9783 

OKLAHOMA 

Oklahoma City 

University of Oklahoma ^fedical 

Center 
H. A, Shoemaker, Ph.D. 
Phone: RE 6-1511, Ext. 358 

OREGON 

Portland 

Oregon Poison Control Registry 
David W, MacFarlane, M. D. 
Phone: CApitol 8-9181 

PEMSYLVAI'IIA 
Harrisburg 
Harrisburg Hospital 
Rosemarie J. Tursky 
Phone: Cedar 8-5221 

Lancaster 

St. Joseph Hospital 
David B, Coursin, M. D. 
Phone: Express 4--7181 

Philadelphia 

Philadelphia Department of 

Public Health 
Emil A. Tlboni 
Phone: WA 2-55^4 

SOUTH CAROLnJA 
Columbia 

Columbia Hospital 
Henry Moore, M. D. 
Phone: Aloine -!^-7387 ' 



TENNESSEE 
Knoxville 
University of Tennessee Memorial 

Research Center and Hospital 
Robert F. Lash, M. D. 
Phone : 4.-2961 

Memphis 

Le Bonheur Children' s Hospital 

W. P. Stepp, M. D. 

Phone: Jackson 5-65/i.l 

TEXAS 

Galveston 

John Sealy Hospital 

S. G. Thompson, M. D. 

Houston 

Baylor University College of 

Medicine 
Harold L. Dobson, M. D. 

UTAH 

Salt Lake City 

Salt Lake County Hospital 

Alan K. Done, M. D. 

Phone: Hunter ii-86l2, Ext. 331^. 

VIRGINIA 
Richmond 

Medical College of Virginia 
Sidney Kaye, Ph.D. 
Phone: Richmond 7-9851 

V/ASHINGTON 
Seattle 

Children' s Orthopaedic Hospital 
Donald H. Sutherland, M. D. 
Phone: Fillmore A300 

Spokane 

Deaconess Hospital 
James M, Fatten, M. D. 
Phone: RI 7-^811 

WISCONSIN 
I-ttlwaukee 

Poison Control Committee 
1513 East Capital Drive 
F. J. Mellencamp, M. D. 

HAWAII 

Honolulu 

Kauikeolani Children's Hospital 

Mr. J. Rhys 

Phone: 5-4563 

(OccMedDispDlv, BuMed) 



Medical News Letter, Vol. 31, No. 5 27 



Notes on Eighteenth Annual Congress 
on Industrial Health 

The Covmcil on Industrial Health of the American Medical Association 
held its Eighteenth Annual. Congress on Industrial Health, 27-29 January 
1958 in Milwaukee, Wis. Captain L. B. Shone MC USN, Director, Occu- 
pational Medicine and Dispensary Division, attended as the representative 
for the Bureau of Medicine and Surgery. 

Cooperating organizations were: The State Medical Society of Wis- 
consin,Medical Society of Milwaukee County, Wisconsin Academy of General 
Practice, Central States Society of Industrial Medicine and Surgery, and the 
Committee on Arrangements selected from the Industrial Health Committee 
of the Medical Society of Milwaukee County. 

Doctor William P. Shepard, Chairman of the Council on Industrial 
Health, American Medical Association, was the General Chairman of the 
Congress and presided at the opening session and at the annual banquet. 

Doctor Harry Kasten, President of the State Medical Society of Wis- 
consin, extended his greetings and emphasized that the purposes of these 
Congresses were to give the people of the United States a better type of 
medical practice and to keep medicine a free enterprise* 

The following subjects which were covered by speakers and panel 
discussions during the three-day Congress have a direct application to 
naval medical practices performed for both military and civilian personnel 
on duty in various naval activities, such as shipyards, air stations, supply 
centers, ordnance depots, and aboard ships. 

Public and Professional Relations in Occupational Health 

General Aspects of Disability Evaluation 

Underlying Philosophies and Current Concepts of Disability: 
Viewpoint of Workmen's Compensation Administrators 
Adjudicative Process in the Veteran's Administration 
Schedule for Rating Disabilities, Veteran's Administration 
Disability Provisions of the Old-Age Survivors Insurance 
Program 

Current Problems in Occupational Dermatoses 

Development and Scope of Industrial Dermatoses 
Oil Folliculitis 

New Causes of Occupational Dermatoses 
Causes of Prolonged and Recurrent Dermatitis 
Evaluation of Disability 



28 Medical News Letter, Vol. 31, No. 5 



Liow Back Pain 

Prevention Through Medical Examination and 
• • Selective Job Placement 

Conservative Management 
Surgical Management 
Evaluation of Disability 

Doctor Gunnar Gundersen, President-Elect of the American Medical 
Association, gave the main address at the annual banquet. Dr. Gundersen 
emphasized the importance of one good strong central medical organization, 
such as the American Medical Association, closer unity in the medical 
profession, free choice of doctor, and guarding against socialized medical 
practices. 

An award was presented to Dr. Lenox D. Baker, Director of the 
Department of Orthopedic Surgery, Duke University, and Medical Director 
of the North Carolina Cerebral Palsy Hospital, Durham, N. C. , who was 
selected by the President's Committee on Employment of the Physically 
Handicapped as a physician who had made an outstanding contribution to 
the welfare and employment of the Nation's physically handicapped men and 
women. (OccMedDispDiv, BuMed) 

University of Pennsylvania Graduate School 
of Medicine Changes Curricula 

Doctor George B. Koelle, Dean of the Graduate School of Medicine 
of the University of Pennsylvania visited the Bureau recently and annoxinced 
a revision of the curricula of the School. Henceforth, tlje eight (8) months' 
courses will be divided into two (2) semesters. The first will be devoted 
primarily to the basic sciences and the second to clinical application and 
practice. Either senn ester may be taken alone or both in sequence. 

Applications will be accepted by the School this year up to 1 August 
1958. Doctor Koelle was especially interested in obtaining applications 
from Reserve officers who are completing their active duty this summer. 

(ProfDiv, BuMed) 

^ SSe 3{C 3JC 3k ^ 

Training Programs in Atomic Medicine 

In view of the increasing importance of atomic medicine in all phases 
of naval operations, a need exists for Medical officers trained in this field. 
Future assignments offer a wfde range of possibilities. The Medical officer 
may serve in nuclear powered vessels, surface craft, or submarines, in 
research or teaching billets, in hospitals, in the field of special weapons 



Medical News Letter, Vol. 31, No. 5 29 



effects and. at various staff levels:. Widely varied training opportunities 
are available. Some of these lead to advanced academic degrees and 
some are accepted for credit by certain specialty boards. Some billets 
in this field are associated with extra pay. In broad terms, the field may 
be divided into three areas: nuclear propulsion, special weapons effects, 
and radioisotopes. There is high transfer value of the basic training in 
this field to permit work in any of the subdivisions. Applicants are urged 
to make their interest known right away, since one course commences early 
in July and another in September 1958. (ProfDiv, BuMed) 

:^ :}: ^ ^ ^ :{: 

Course in Blood Procurement, Storage, and 
Utilization for NC Officers 

Attention is directed to a course of instruction in Blood Procurennent, 
Storage, Utilization and Other Kestorative Fluid Therapy for Navy Nurse 
Corps Officers. The curriculum will include instruction in the principles 
of operating a Donor Center, procedures for blood typing and all cross- 
matching methods, titration, and collection, and storage of blood. 

Duration: Four (4) months 

Place: U.S. Naval Medical School 

National Naval Medical Center 
Bethesda, Md. 
Convening dates :14 April 1958 - Course ends; 1 August 1958 

1 Sept 1958 - Course ends: 19 December 1958 
Qualifications: 1. A minimum of three years active duty in Regular 

or Reserve Nurse Corps. In case of Reserves, 
extension of active duty must be of sufficient 
duration to cover an eighteen {18) months period of 
obligation from completion of the course. 
Z. An individual who has a sound professional back- 
ground related to this training, personal and pro- 
fessional maturity and stability, and who can 
demonstrate teaching ability, skill in working with 
people, and is attentive to details. 
3. Acceptable High School and School of Nursing 
grades with a good background in the sciences. 
Obligated Service: Eighteen (18) nnonths after completion of the course. 

Official letters of request should be directed to the Chief, Bureau of 
Medicine and Surgery, Attention: Code 32. (NursDiv, BuMed) 



30 Medical News Letter, Vol. 31, No. 5 



Obstetrical and Gynecological Seminar 

The Commanding Officer of the National Naval Medical Center 
announces the Fifth Annual Armed Forces Obstetrics and Gynecology Sem- 
inar to be held at the National Naval Medical Center, Bethesda, Md. , on 
May 5-9, 1958. 

The panel type seminar will be attended by medical officers of the 
Army, Navy, and Air Force stationed throughout the United States, at sea, 
and at foreign stations. In addition, it is anticipated that a number of 
Reserve Medical officers of the Arnned Services on inactive duty will attend. 

Many nationally known consultants as well as outstanding Medical officers 
will discuss clinical problems peculiar to the specialty. (NNMC) 

sfa ^ jte ^ ^ jfe 

Space Medicine Branch of the 



Aero Medical Association 



Recent events have brought the subject of space medicine to the force- 
ful attention of the world. Few people are aware of the fact, however, that 
there has been a group of aviation medical personnel who have been interes- 
ted in this subject and actively doing something about it for a number of 
years. All persons who are members of the Aero Medical Association and 
who are interested in joining the Space Medicine Branch are eligible to do 
so. Of the 139 Naval nnennbers of the Aero Medical Association, only 34 
are at present members of the Space Medicine Branch. It is believed that 
others might be interested in joining this group. 

Applications for membership may be sent to Captain P. B. Phillips 
MC USN, U. S. Naval School of Aviation Medicine, Naval Air Station, 
Pensacola, Fla, , or to Captain C. P. Phoebus MC USN, Office of Naval 
Research (Code 408), Department of the Navy, Washington 25, D. C. 

(AvMedDiv, BuMed) 

^ >J; s[s t! ii: :}: 

Recent Research Reports 
Naval Medical Research Institute, NNMC, Bethesda, Md. 

1. Effect of Variation of the Casein and Sucrose Levels in the Diets of 
Rats on Caries Activity and the Composition of Mineralized Tissue. 
NM 75 01 00. 01, 02, 30 September 1957. 

2. Adenosinetriphosphate-Adenosinemonophosphate Transphosphorylase 
m. Kinetic Studies. NM 01 01 00.02.01, 4 October 1957. 



Medical News Letter, Vol. 31, No. 5 31 \ 



3. Direct Nonsuture Coronary Artery Anastomosis in the Dog. NM 71 03 
00.01.01, 4 October 1957. 

4. The Biological Basis of Rodent Control. Lecture and Review Series. 
No. 57-3, 4 November 1957. 

5. Action of Some Diamine Optical Antiposed on Acetylcholinesterase 
Inhibition and Conduction in Desheathed Bullfrog Sciatic Nerve. NM 02 02 
00.01.04, 6 November 1957. 

6. Action of Certain Anticholinesterase Inhibitors on the Spike Potential 
of the Desheathed Sciatic Nerve of the Bullfrog. NM 02 02 GO. 01. 05, 

7 November 1957. 

Naval School of Aviation Medicine, Pensacola, Fla. 

1. Interdependence of Successive Judgments. I. Comparative Judgment, 
II. Affective Judgment, UI. Absolute Judgment. NM 14 02 ll,Subtask 12. 
Report No. 2, 31 July 1957. 

2. Delayed Response: Effects upon Speech Reception and Speaker Intel- 
ligibility. NM 18 02 99, Subtask 1. Report No. 74, 15 August 1957. 

3. A Note on the Refinement of the Pre -Flight Navigation Grade when 
Used as a Predictor of Flight Failure. NM 14 02 11, Subtask 1, Report 
No. 24, 2 September 1957. 

(To be continued in the next issue) 

****** 

IN ME MORI AM 

RADM Perceval S. Rossiter MC USN (Ret) 22 December 1957 

CAPT Melvin D. Abbott MC USN (Ret) 17 February 1958 

CAPT Forrest M. Harrison MC USN (Ret) 21 December 1957 

CAPT Edward L, McDermott MC USN (Ret) 12 January 1958 

CAPT George W. Shepard MC USN (Ret) 3 February 1958 

CAPT Leo C. Thyson MC USN (Ret) 9 January 1958 

CDR Thomas F. Gowen MC USN (Ret) 19 October 1957 

CDR Albert B. Larson DC USN (Ret) 27 November 1957 

CDR James P. Smith MC USN (Ret) 24 January 1958 

LCDR Arthur H. Pierson MC USN (Ret) 9 November 1957 

LCDR Frederic N. Pugsley MC USN (Ret) 6 November 1957 

LT DeWitt C. Allen MSC USN (Ret) 14 January 1958 

LT Douglas W. MacDonald HC USN (Ret) 13 January 1958 
CHMEDSERWRNT Clarence E. Godfrey USN (Ret) 15 January 1958 

CHMEDSERWRNT Earl J. Kane USN (Ret) 4 September 1957 

CHMEDSERWRNT Louis N. Novak Jr. USN 17 February 1958 

* * * 3js 3{c :}: 



32 Medical News Letter, Vol. 31, No. 5 



From the Note Book 

1. Rear Admiral B. W. Hogan, Chief of the Bureau of Medicine and Surg- 
ery, has commended LCDR J, H, Ebersole MC USN, Medical Officer 
aboard the USS Seawolf . LCDR Ebersole made a trip to the United King- 
dom, December 2-17, 1957, and was most successful in furthering the 
liaison between the Royal Navy and the U.S. Navy in the field of sub- 
marine medicine according to Admiral Hogan. in his commendation letter. 

(TIO, BuMed) 

2. CDR M. A. Mazzarella DC USN, on duty at the U. S. Naval Administrative 
Command, U.S. Naval Training Center, Great Lakes, 111., recently pre- 
sented an essay on "Naval Research in Cairo, Egypt" before the Chicago 
Section of the International Association for Dental Research at Northwestern 
University, Chicago, 111. (TIO, BuMed) 

3. The National Bureau of Standards and the National Academy of Sciences- 
National Research Covincil have announced an expanded plan for coordina- 
tion of the Bureau's technical advisory committee program by the Academy- 
Research Council in cooperation with a number of the major professional 
scientific societies of the United States, The new plan for coordination of these 
advisory activities by the Academy-Research Council will strengthen the 
current program by allowing more complete coverage of the Bureau's diver- 
sified research activities, and by providing for the coordination of recom- 
mendations from the various professional interests which the Bureau serves. 

(NBS) 

4. The number of deaths from all causes increased slightly in the 114 
large cities during the week ended February 1, 1958, as compared with 
the previous week. The numbers were 12,858 and 12,753 respectively. 
Deaths from influenza and pneumonia increased from 675 to 750. The 
increases in influenza and pneunnonia deaths occurred in the cities of the 
Middle Atlantic, West North Central, South Atlantic, and West South Central 
Divisions. The cumulative total since September 1, 1957 is 12,475 as conn- 
pared with 7, 317 for the same period 1 year ago, 7, 110 in 1955-56, and 
6,533 in 1954-55. (PHS, HEW) 

5. The Pacific War Memorial Committee of Hawaii is planning to construct 
a permanent memorial to USS Arizona at Pearl Harbor. Surviving members 
of the crew and others interested are invited to write the Chairman, USS 
Arizona Mennorial, Pearl Harbor, T. H. (Navy Reservist) 

6. The comparative value of 6 different nitrites in the treatment of angina 
pectoris when administered by the oral, sublingual, subcutaneous, and 
percutaneous routes was studied in 34 patients by measuring the amovmt 
of work that could be performed under standardized conditions without 



Medical News Letter, Vol. 31, No. 5 33 



producing angina and also by observing the clinical response and the exer- 
cise electrocardiogram. (Circulation, January 1958; J. E.F. Riseman, 
M. D. , G.E. Altman, M. D. , S. Koretsky, M. D. ) 

7. Translumbar aortography is of value as a diagnostic procedure, but 
only as an adjunct to simpler, safer, and more revealing studies. The 
hazards of the procedure must be carefully weighed against the probable 
information to be received. Six cases of untoward reactions to translumbar 
aortography are presented, including paraplegia, perirenal abscess, retro- 
peritoneal hemorrhage, chemical pyelonephritis, and extravasation of dye 
with severe pain. (Arch. Surg., January 1958; J. E. Anthony, Jr.,M. D. ) 

8. The author's experience indicates that, in the vast majority of instances, 
it is possible to carry women with heart disease safely and productively 
through pregnancy. Success depends on the understanding and careful 
application of the principle of the total cardiac burden and on making 

a wide appraisal of the factors in pregnancy and in other aspects of the 
patient's life which influence this burden. (Arch. Int. Med. , January 1958; 
C, S. Burwell, M. D. ) 

9. A technique for bronchography employing cyclaine topical and local 
anesthesia, tracheal puncture, and dionosil opaque medium is presented. 
This or similar procedure is recommended for more widespread usage 
because of minireial equipment requirement, sinnplicity, and freedonn from 
reaction to an anesthetic agent. (Am. J. Roentgenol., January 1958; 

R. E. Beck, M. D. , A. A. Hobbs, Jr., M. D. ) 

10. Comparison of 100 normal adult male and 100 nornnal adult female 
skulls has been made from a roentgenologic standpoint. They were com- 
pared as to sagittal diameter, mastoid length, mandibular width at the 
level of the mastoid tips, and mandibular angle width. The connparison of 
the findings shows that there are characteristic dimensions for the male 
and female and that sex can be predicted in 88%. (Radiology, January 1958; 
J. L. Ceballos, M. D. , E. H. Rentschler, M. D. ) 

11. In the treatment of cancer of the tongue, the primary tumor can be con- 
trolled essentially with equal effectiveness by surgery or by irradiation. 
For lesions at the base of the tongue, irradiation is probably superior. 
Radical neck dissection is the treatment of choice for metastatic disease. 
(Surgery, February 1958; H. W. Southwick , M. D. , et al. ) 

The printing of this publication was approved by the Director of the 
Bureau of the Budget, 16 May 1955. 



54. Medical News Letter, Vol. 31» No. 5 




DEIMTAL i ^^ . I SECTION 



Manual of Medical Department Chapter Six 

Chapter 6, The Navy Dental Service, Manual of the Medical Depart- 
ment, is now being distributed as part of page change 6 of the Manual and 
will be effective upon receipt. 

The new chapter consolidates, insofar as practicable, all matters 
pertaining to or of interest to Dental officers. Medical Service Corps 
officers in dental activities, Dental Service Warrant officers, and Dental 
Technicians. Where undesirable duplication might occur, reference is 
made in Chapter 6 to other parts of the Manual or to other pertinent direc- 
tives. Some major changes incorporated in the new chapter are: 

1. Redesignation of the title from "The Dental Corps" to "The Navy 
Dental Service" to conforin with the general contents of the chapter, 

2. Inclusion of a new section outlining the primary functions and 
general responsibilities of the Navy Dental Service. 

3. Inclusion of a new section outlining the responsibilities of the 
Dental Division, Bureau of Medicine and Surgery, as it relates to the 
Navy Dental Service. 

4. Inclusion of a new section on dental standards which brings together 
into one section all dental standards. Dental standards are still included 
in Chapter 15 tinder the various types of physical examinations. 

5. Inclusion of a new section on planning of dental facilities. 

6. Inclusion of a new article which specifically prohibits the conduct 
of a private practice by Navy Dental officers on active duty. 

* ^ :{! ;^ :{: !): 

Change of Entries on Standard Fornn 603 

BuMed Notice 6620, Dental Record, Standard Form 603 modifies 
the procedure for making entries in item 16 of the Dental Record, Standard 
Form 603. 

Article 6-75, Manual of the Medical Departnnent, requires that the 
markings on all charts of the Dental Record, SF 603, shall be made in 
blue or blue-black ink. Diseases and abnormalities which are found by 
dental examinations subsequent to the original examination are marked 



Medical News Letter, Vol. 31, No. 5 35 



on the dental chart in Item 16 of the SF 603. Experience has shown that 
after several examinations and treatments, these markings lose value in 
indicating the status of an individual's requirements for treatnaent. 

BuMed Notice 6620 modifies the procedure so that all future entries 
in Item 16 of the SF 603 shall be made in pencil. When the condition for 
which the entry was n^ade has been treated or no longer exists, the entry 
shall be erased. 

*r ^f T^ 'r T* f 

Changes in Rating 

BuPers Notice 1440 establishes the procedure for effecting changes 
in the DT rating to conform with modification of the Enlisted Rating Structure. 

The Secretary of the Navy approved, on December 14, 1957, the dis- 
establishment of the emergency service ratings. Dental Technician G (Gen- 
eral), Dental Technician P (Prosthetic}, and Dental Technician R (Repair). . 

This notice authorizes and directs commanding officers to change 
rating, in equal pay grade, of the Naval Reserve and Fleet Reserve person- 
nel on active duty from the above emergency Service ratings to Dental 
Technician, (DT), These changes are to be effected between March 1, 1958 
and July 1, 1958. 

Changes in rating involving members of the Naval Reserve and Fleet 
Reserve on inactive duty will be the subject of separate correspondence 
addressed to commands charged with administering their records. 

" Operation Build-Up " 

"Operation Build-Up" on February 1, 1958, of the Dental Corps, 
Regular Navy, reached another peak with a total of 967 officers on active 
duty. This is an increase of 268 career Dental officers since August 1954. 
(See chart) 

^ Jlfi ^ iji ^ ^ 

Change of Address 

Please forward requests for change of address for the News Letter to; 
Con^manding Officer, U. S. Naval Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 



DENTAL OFFICERS 
APPOINTED IN THE 

U.S. NAVY_ 



rURINQ THE ?EHIOD 
1 HOVBMBEH 1957 TO 
1 FEBRHMCr 1??8 

ARTHUR aUXEltS, JS 
QBDT^ Q. BEEIfil 
GHUOES H. CLARK 
MALOOIM S. UTIS 
DONALD C. QONDBt 
WILLIAM F. KALE 
THCHAS tr. HOFKDiS 
ROBERT J. LEDPOU) 
JOHN S. LINDSAT 
CALVIN D. NESTSi 
BARRT E. PIKES 
WILLIAM H. FRAIIOE 
JOHH N. REICHHELD 
ROBOtT H. SADUTO 
JAMES A. VAN DTEE 
FRANCIS A. HARD. 




,050- AUTHORIZED MAXIMUM | 

1,000 

967-1 FEBRUARY 1958 



862- I JANUARY 1957 



700_699_25 AUGUST 1954 



Medical News Letter, Vol. 31, No. 5 37 




RESERVE SECTION 



Participation in Reserve Medical Program 
in a Pay Status 

Participation in the Reserve Medical Program in a pay status for any- 
Medical Department Reservist is available through the following: 

A. Attendance at weekly drills of units of the Surface, Submarine, 
Aviation, Construction Battalion, Electronics, Marine Corps Reserve, 
and Hospital Corps Programs of the Naval Reserve. These units schedule 
48 drills per year in a pay status and members are required to perfornn 
annual 14-day active duty for training with pay. Medical officers attached 
to these units perform physical examinations and related tasks incidental 
to the medical support of the unit; Medical Service and Nurse Corps 
officers and Hospital Corpsmen assist the medical officers as necessary. 
Hospital Corps Divisions consist of Medical Department personnel only 
and provide specific training for Reserve Hospital Corpsmen. Medical, 
Medical Service, and Nurse Corps officers serve as instructors in these 
units. 

B. Active duty for training at seminars, schools, special training 
courses and on-the-job duty at any suitable Naval activity, Naval hospital, 
or cruising Naval vessel. Developed jointly by the Bureau of Naval Per- 
sonnel and the Bureau of Medicine and Surgery, this type of training 
requires the inactive Reservist to report aboard a naval activity or vessel 
for the purpose of acquainting him with what the active Navy is doing. It 
affords the individual an opportunity to be brought up to date on the latest 
procedures, tactics, equipment, and military leadership. Thus, this 
training is considered to be the most valuable part of the Reserve Training 
Program, Active duty for training is available to Medical Department per- 
sonnel attached to, or associated in, a pay status of pay units of the 
Naval Reserve within funds appropriated for this purpose. 

C. Appropriate duty with pay . This type of training is available to 
inactive Medical and Nurse Corps officers of the Naval Reserve. Med- 
ical officers perform physical examinations and provide such medical 
support as is required for the function of the Reserve Training Center. 
Nurse Corps officers perform related tasks incidental to the medical sup- 
port of the Reserve Training Center. Commandants are authorized to 
issue appropriate duty with pay orders to qualified individuals within 
established quotas. Appropriate duty with pay may be performed no 



38 Medical News Letter, Vol. 31, No. 5 



oftener than once per calendar week within a maximum of 48 per year. 
IN ADDITION TO PROVIDING PAY, MEMBERS OF THE PAY PROGRAM 
OF THE NAVAL RESERVE EARN BOTH RETIREMENT AND PROMOTION 
POINT CREDITS. 

^ :{: :^ ^ s;: :js 

Training Course for Inactive Reservists 

A fourteen-day active duty for training course in Disease Vector and 
Economic Pest Prevention and Control is available to inactive Reserve 
officer and enlisted Medical Department personnel beginning on the first 
Monday of March, April, and June, and the third Monday of February and 
May, 1958, at the Naval Disease Vector Control Center, NAS, Jacksonville, 
Fla. 

Medical Department Reservists from the First, Third, Fourth, Fifth, 
Sixth, Eighth, and Ninth Naval Districts are eligible, within funds available 
for this training which features a series of comprehensive lectures, demon- 
strations, and field experiments related to vector and pest prevention and 
control procedures with special reference to naval preventive medicine 
aspects. 

Security clearance is not required. Interested eligible Reservists 
should subnnit their request to the Conrjmandant of their home Naval District 
at the earliest practicable date. 

:{« ^ »{; »{c ^ sic 

Annual Meeting of Aero Medical Association 



The twenty-ninth annual meeting of the Aero Medical Association will 
convene at the Statler Hotel, Washington, D. C. , during 24 - Z6 March 
1958. 

The scientific program for presentation includes sessions on protec- 
tion at extreme altitude, accidents and flight safety, the physiology of 
high altitude flight, the physiology of stress, space medicine, environ- 
mental physiology, clinical problems, and aviation psychology— all of 
which has a direct military application and provides information essential 
to the performance of military medical duties. 

Eligible inactive Reserve Medical Department officers have been 
authorized to receive one retirement point credit for each day's attendance, 
provided they register with the military representative present. 



Medical News Letter, Vol. 31, No. 5 



39 




^^^^^^ MEDICIIME SECT101\[ 



Antibiotic Residues in Food 



Antibiotics in Food Preservation (Science, 1Z 6: 1159-1161, 6 December, 
1^51t by Henry Welch, an official of the U, S. Food and Drug Administration, 
contains the following public health and regulatory aspects of antibiotic resi- 
dues in the food supply. 

"During the . . . three years, (1954, 1955, and 1956) three surveys 
have been made of fluid market milk to deternnine its antibiotic content. 
In these surveys, a total of 2274 samples were examined and samples 
from all states were included. An average of 6.9% of the samples examined 
contained penicillin in concentrations varying from 0. 003 to 0. 550 vinits per 
milliliter. Other dairy products tested, including powdered milk, evap- 
orated milk, ice cream, butter, cheese, shell eggs, and broken eggs, 
were found to be free from antibiotic residues. 

The relatively large number of positive samples noted in the year that 
separated the first and second surveys caused some concern and it seemed 
advisable to obtain some opinion on the possible public health significance 
of the presence of penicillin in these quantities in market milk. Accord- 
ingly, some 30 experts in the fields of antibiotic therapy, allergy, and 
pediatrics were asked to express their views on this matter. The majority 
of these experts believed that penicillin in these amounts is unlikely to 
modify the oral or intestinal flora, cause the emergence of resistant 
strains, or provoke sensitization of an insensitive person. However, the 
nnajority felt that such concentrations might possibly cause a reaction in a 
highly sensitive individual. Recently, the Food and Drug Administration 
has taken three steps to alleviate the public health problem involved: 

1. Through cooperation with the U.S. Department of Agriculture, an 
intensive program has been initiated to educate the farmer concerning 
the innportance of discarding, or using for purposes other than human 
consumption, milk from cows treated for mastitis with antibiotic drugs 
for a period of three days following the last treatment. In addition, the 
National Milk Producers Federation which reaches some 500,000 farmers 
is assisting in this education program through their state agents. 

frU. S. GOVERNMENT PRINTJMQ OFFICE i l^^S O - 441840 



40 Medical News Letter, Vol. 31, No. 5 



2. On Z3 January 1957, a notice was published in the Federal Register 
concerning a proposal of the warning statement regarding disposition of 
milk from treated cows which is required in the labeling of antibiotic 
drugs intended for intramammary infusion. It was proposed that this 
warning be placed on the immediate container of the drug rather than in 
the literature accompanying it. This is now in effect. 

3. On 9 February 1957, a 'Notice of Proposed Rule Making' was pub- 
lished in the Federal Register, limiting the penicillin content of mastitis 
preparations to 100,000 units per dose. This became effective on 12 Aug- 
ust, 1957. 




It is hoped that these three steps will alleviate the problem of antibio- 
tics, particularly penicillin, being present in our milk supply. However, 
if these procedures are unsuccessful, it may be necessary to ban the use 
of penicillin in mastitis preparations in the United States. 

The control of antibiotics in our food supply becomes more complex 
daily. We now have before us for consideration the use of chlortetra- 
cycline and oxytetracycline in fish as a means of extending 'shelf life. ' 
Unfortunately, in contrast to demonstrations with poultry, we have been 
unable to demonstrate that ordinary methods of cooking treated fish 
(broiling, frying, boiling, or baking) eliminate the residual antibiotic. 
Furthermore, some fish are eaten raw, smoked, or pickled, and in all 
these cases the consumer would ingest antibiotic residues. Before toler- 
ance levels can be established for these antibiotics in fish, it will be 
necessary for those requesting them to demonstrate that the residues 
fo\md are not dangerous to public health. '• 



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